The least loved institution in America today is the U.S. Senate, and one of the reasons it is reviled is a zero-sum approach to women’s medical care. It’s time we changed that and adopt modern policies that make sense instead of using women’s medical issues as an election-year power play. One of the most rational ways for Washington to break this gridlock is to approve oral contraception for over-the-counter purchases by adults.

Since “the pill” was first approved 44 years ago, it’s been one of the most proven and tested pharmaceuticals of our time. It is safe, reliable, effective, and presents very few risks or complications for the more than 10 million women who use it. When other drugs have that kind of track record, we approve them for purchase without a prescription; the Food and Drug Administration has already reclassified over 100 different treatments. Name-brand drugs like Advil, Pepcid, Claritin, Prilosec and many others were once sold by prescription only, but moved to over-the-counter sale (OTC) once they’d been proven safe and unlikely to be abused.

When treatments go over-the-counter, two things happen: they get dramatically cheaper and consumers save time and hassle by avoiding unnecessary doctors’ appointments just to get the pharmaceuticals they already know they need.

(…)

Since January 2011, an obscure provision of Obamacare has blocked insurers from covering OTC medicine without a prescription. If Democrats are serious about making oral contraception affordable and accessible, we can reverse that technical provision.

Driving the price down for a safe medicine is a better way to provide access to adults who want it than President Obama’s insurance mandate. Many women don’t have access today in spite of the Obamacare mandate, and it violates religious liberty in the process. If a new generation of senators puts partisanship aside, we can protect the liberties of women to have easy access to affordable oral contraception at the same time we protect the rights of those with conscience objections.

Moving oral contraceptives to OTC status is not a new idea: A committee of the American College of Obstetricians and Gynecologists recommended the switch in 2012, citing a scientific trial that proved pharmacists and women themselves could effectively screen potential patients without the inconvenience and cost of a doctor’s visit.

Since it makes so much sense, you might wonder why this change has not happened yet. It’s because too many people in Washington would rather play politics with contraception instead of actually making life easier for women. Too many Democrats prefer to attack Republicans on the issue of contraception rather than actually make contraception more available and affordable and too many Republicans are afraid to break the mold.

It’s hard to find any real fault with Gardner’s argument here. After lengthy litigation, the FDA recently went ahead and made Plan B and other “morning after” pills available over the counter for women as young as fourteen years old. As Gardner notes in his Op-Ed, the American College of Obstetricians and Gynecologists formally endorsed the idea that birth control pills should be sold over the counter, arguing that the pills themselves are generally safe enough to be sold over the counter and that wider availability of birth control would go a long way toward cutting down on unintended pregnancies, something that should appeal to both the left and the right in the end. Given that, and assuming that the medical evidence in favor of wider access to birth control pills is as solid as the medical arguments in favor of making Plan B available without a prescription, it seems to me that there is little if any rational reason to oppose the idea of allowing women, and even teenagers, to obtain birth control over the counter. Realistically, it would probably the case that the birth control pill would be treated as a “behind the counter” drug in the way some OTC drugs that can be used to manufacture illegal drugs have been, but that would obviously make the drugs far more widely available, which seems like a good thing.

Gardner also makes a good point that making contraceptives available without a prescription would eliminate most of the politics surrounding the issue of birth control, especially as it relates to mandatory insurance coverage. Hobby Lobby and other companies wouldn’t have to worry about providing birth control coverage to their employees, state and federal legislators wouldn’t have to fight over an issue that was settled decades ago, and in the end the entire issue would go back to the medical profession where it belongs. There may be some arguments that women who need to take birth control for medical reasons unrelated to preventing contraception shouldn’t be able to self-medicate without talking to a doctor, but that strikes me as the kind of paternalism based argument that the entire concept of the pill was supposed to have put behind us.

Theoretically at least, this is something that the FDA could do all on its own just as it did with Plan B. All it would take is a new regulation along the lines of the one issued for those drugs. However, given the political firestorm that this issue typically creates it may be wise to have Congress deal with this first. If that doesn’t happen, though, I’d be fine with the FDA taking a step that seems so obvious that one wonders why it hasn’t happened sooner.

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About Doug MataconisDoug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway.
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Comments

It would resolve some of the issues around birth control, it would not resolve issues regarding IUDs and the much more expensive versions of the pill that are used in more complex medical issues. While I think this is a good thing, and hope it passes, including the allowance for prescription drug plans to cover over the counter medications, I don’t envision it getting through the house without a poison pill that would be completely unacceptable.

Instead of trying to kill the ACA, this is what congress should have been doing the entire time, finding ways to make the program better. If they start to do that, I will be pleasantly surprised, but not holding my breath.

Nice work on ignoring the context of why Gardner is proposing this now: he had been an avid supporter of the Colorado personhood amendment, and is a co-sponsor of a personhood bill in Congress. Now that he is getting hammered over the issue, he is beating a hasty retreat.

As for the substance of the issue, yes, selling the pill OTC is a good idea, but it won’t resolve the political conundrum. The issue here is that there is a small, but significant, percentage of women, who have to cycle through increasingly sophisticated and expensive varieties of the pill, due to all sorts of complications, a process that requires various consultations with doctors. If one takes the position that contraceptives are an essential benefit, as current law does, you still need to have some form of mandate to attend to the needs of this group.

Most women who us e BC pills use them with no trouble and no need to work through pills.

Why should they have to go to their doctor for a prescription when the same brand has worked just fine for the last 6 months? This is the vast majority of women.

And if you have a condition that requires moving through more and more expensive pills then you should be seeing your doctor anyway whether the pills are on the shelf or require a scrip.

The one downside is that currently to get a scrip for BC pills you have to see your doctor every year to have it refilled. If BC pills are OTC then some women may take a pass on the yearly Pap smear and pelvic exam.

It seems to be a common sense approach, but what would the annual cost be? Is this something that would place a financial burden on women once the pills are no longer a prescription that is covered by insurance?

It’s because too many people in Washington would rather play politics with contraception instead of actually making life easier for women.

While it’s strange to hear this from a Republican, it’s even stranger to hear it from a Republican who clearly doesn’t believe it.

As humanoid.panda points out, Gardner is one of the “many people in Washington (who) would rather play politics with contraception.” Part of the reason he’s changed his tune now is that he’s discovered, to his shock no doubt, that Colorado voters are not amenable to “personhood amendments” or pretty much anything else on the “pro-life movement” want-list.

That said, there’s two ways to take this: A) As a cynical attempt to deceive voters so he can get elected or B) a genuine attempt on his part to represent the views of the people he represents in Congress.

It depends. Online you can get them very low-priced. Walmart, if you care to shop there, sells the generics for $9. I read an interesting survey of pill prices in New York. On the upper east side of Manhattan, they could run as much as $164 per month in an expensive pharmacy. At the Walmart in Brooklyn, though, they were 9 bucks. The retailer can sell them for what he or she wishes, and what the market will bear.

Given that, and assuming that the medical evidence in favor of wider access to birth control pills is as solid as the medical arguments in favor of making Plan B available without a prescription, it seems to me that there is little if any rational reason to oppose the idea of allowing women, and even teenagers, to obtain birth control over the counter.

I think I have spotted a fly in your logic Doug. Seriously, what in the name of Dog ever gave you the idea that the religious right has any intention whatsoever of ever allowing any woman to have control over her own body? It is not a body, it is a vessel placed on this earth by the Lord Dog Almighty for the sole purpose of bringing forth life. After that they don’t care what happens to it.

@Grewgills: @David in KC: Normally, I’d agree with you, being personally quite liberal on the subject and skeptical of right-wing efforts to promote a pro-life agenda.

However, on Gardner I’m not sure. He doesn’t seem to be loading a Trojan Horse for a post-election right-ward turn. He seems to be trying to beat Mark Udall* and you are not going to beat Mark Udall by being the biggest pro-lifer on the block.

* Udall not only belongs to the Udall political family, but he’s one of the most prominent and ambitious Democrats in an increasingly blue state.

Could have sworn there was one on Court Street, according to my sister, but I could be wrong. Anyhow, here’s a site that shows the price range of some of the products: finance.yahoo.com/news/37-162-strange-world-birth-10300429.html

I suspect off bc pills would get cheaper. I know when my daughter’s allergy med first went off the generic ran almost $20 for 60 pills but now I can get 120 for about $10. It’s much easier buying meds that pose little risk otc.

From Colorado Pols.com: “Gardner’s solution to this problem may too go down in history, especially in the event it is successful. Gardner’s strategy to drop his long-established hard line positions on abortion like a hot brick, hoping to neutralize the issue before the general public tunes back in to politics this fall, is without hyperbole one of the most audacious political gambits we have seen in our years covering politics. Gardner is not just flip-flopping, he is trying to cast himself as the enemy of his former self on issues he knows are losers with the statewide electorate. It goes well beyond “politics as usual,”

“Congressman Gardner has a disturbing record of supporting radical measures to limit, and even outlaw, women’s access to contraception. His flailing efforts to remake his image serve as an admission that his extreme beliefs and reckless agenda are out-of-step with mainstream Colorado values,” said State Rep. Angela Williams in a statement blasted out by Udall’s campaign.

What? You mean have them take responsibility, including financial, for their own birth control?

Do you pay 100% of your medical and pharmaceutical costs out of pocket? If not, I suggest you are being somewhat hypocritical.

I am weary of right wing attempts to make reproductive choice harder for women to obtain, with good reason. I have no idea what birth control costs, when I was younger, I let women worry about that, and as a married guy who is pushing 60 it is no longer an issue.

That being said, I want young women to have choice, and without an unreasonable financial burden.

rather questioning what would come out of a republican house, or possibly a republican senate.

Considering that a pro-life, anti-contraception agenda is only going to play in a safe, gerrymandered House district. The chances of Colorado sending a pro-life, anti-contraception Senator to Washington anytime soon is basically nil.

In other words, I would expect a Republican House or Senate to continue pursuing a pro-life, anti-contraception agenda, with Gardner continuing to support that agenda from the House, while Udall keeps his Senate seat.

Doug- When used for reasons other than contraception they can be difficult to manage and more expensive. Insurance should cover those costs, and it is not paternalistic. One of my female physicians is having to work with a GYN doc to address some of her issues and modify her meds.

@anjin-san: This is so true. I wouldn’t support this based on some vague “they’ll be cheaper when they’re over the counter”. This would need to be carefully evaluated based on whether the cost is affordable enough. There’s no point making them more accessible if the cost keeps women from using them. Having access to affordable family planning saves society money in the long run.

I will never forget a visit to Planned Parenthood for an STD check back in my swinging bachelor days. I was stunned by the level of security, right down to to a reception desk encased in bulletproof glass. When I asked about it, the response was “we don’t want any of our people or patients getting hurt.” This was in liberal Marin County, not in some red state backwater.

It was pretty eye opening for me as far as the problems that have been created for women who simply want to have control over their own bodies, something men take completely for granted.

@anjin-san: I hear you. My wife worked at Planned Parenthood office for several years and it used the same building as a clinic. No bullet proof glass but you can bet the staff was worried about the largest single group of terrorists in the country – crazy right wingers.

And FWIW, all of the medical staff could have made more money elsewhere, but the crazies chanting out front and the real needs of their patients just made them double down more and more. And of course all those crazies out there knew they could bring themselves or their daughters to the clinic for an abortion (although abortion was a very small percentage of what they did there) and the staff would never let on as they passed them a week later, once again chanting about baby killing in the front. And yes that happened there and every clinic veteran all over the country can tell similar stories that happened at their facility.

@CSK: It caught my eye because Mrs pedals and I talked about how weird it was the Waltons would pass on New York City (say it like the picante commercial). She’s up there this week. Her brothers confirm there are still no Walmarts in NYC, supposedly because it can’t suffer the presence of a unionized workforce.

@Grewgills: Where are you getting them that cheap? When we first moved back here almost 4 years ago with no jobs and no insurance my wife had to pay $40 for low dose bc pills.

During the whole Sandra Fluke idiocy, someone found several places within 10 minutes’ walk of her campus that sold a month of BC pills for $10 or less.

@rudderpedals: It caught my eye because Mrs pedals and I talked about how weird it was the Waltons would pass on New York City (say it like the picante commercial). She’s up there this week. Her brothers confirm there are still no Walmarts in NYC, supposedly because it can’t suffer the presence of a unionized workforce.

Not knowing this politician, my reaction was that this could easily make a lot of women pay more. My kid has bad allergies. The fact he has a prescription allegry drug saves me a bundle of money, because the OTC or even the on-the-shelf stuff would be additionally out of my pocket.

I’d be paying twice. Once when I work and earn the health care benefit my employer provides and once when I buy the medication.

So sure, the pill might be cheaper as a product, but that doesn’t mean the buyer saves money, unless she is either compensated more or if her contribution to the health care plan is reduced.

@Jenos Idanian #13: It’s true they draw protests. Community activists in LA were protesting Walmart not long ago IIRC. Maybe they don[t want to deal with it.

Staten Island is an aberration though. Big chunks of it are friendly to the big box stores like every other suburb in the country. They could make money there but I don’t think they want to be in a situation where they make money in spite of being compelled to deal with a unionized workforce.

someone found several places within 10 minutes’ walk of her campus that sold a month of BC pills for $10 or less.

Let’s look past the fact that you can’t manage a supporting cite here and say this was the case for the sake of argument. So what if they did? To make a meaningful argument (a stipulation that pretty much leaves you out), you would have to produce nationwide data proving affordability. “I heard that someone said that you can afford it in this one place” is kind of a lame argument, even by your anemic standards.

@anjin-san: If I recall correctly, the issue was that the student Sandra Fluke was testifying about needed bc pills for PCOS or something along those lines. Under those circumstances, it is very doubtful that OTC bc pills are going to be what a doctor would use to treat that condition (at least initially). The fact still remains that she was paying for health insurance to cover her health care, and the need for bc pills was part of her healthcare. Why should she pay twice, as noted above by those wiser than me, for the same healthcare coverage?

@Blue Galangal: Fluke chose to attend a Catholic university that explicitly abides by Catholic beliefs. She disagreed with those beliefs, and demanded that the school set aside its own principles and beliefs to indulge hers.

If the pills in question were for other purposes than birth control, or even JUST birth control, then she might have had a case. But she was demanding that the school violate two major tenets of Catholicism for her convenience.